Responses from the Frontline:How Organisations and Street-level Bureaucrats Deal with Economic Sanctions

Economic sanctions have gained more political legitimacy and are being more widely used as a tool to improve the willingness of unemployed welfare recipients to participate in activities within the framework of active labour market policy (ALMP). The focus of this article is the use of economic sanctions on cash benefit recipients in Denmark, Quantitative analyses show a substantial increase in the use of economic sanctions in Denmark, including sanctions on those who are categorised as having problems in addition to unemployment. In this article we will direct our attention to responses from both the organisational and individual level regarding the implementation of sanctions. Empirical material consists of interviews with managers and frontline social workers in municipalities with a high number of sanctions. We argue that organisations matter in shaping street-level behaviour, resulting in substantial differences in the use of sanctions from one municipality to another. </jats:p

The long road to data-driven decision-making : How do casework registrations become management information?

The implementation of digital technologies in organisations is often seen as a means by which to ease the administrative burden, create transparency, and to provide for better management information. Based on in-depth interviews with social workers, admin staff, and managers from eleven Danish municipal disability offices, this paper shows the nuances of the perceptions and ambitions to make management and welfare organisations data-driven. The article maps the infrastructures making management information possible. When social workers insert data in digital case management systems (CMS) on clients, services, and service costs, it becomes possible to extract this data and use it as management information. However, achieving this requires much more than a few clicks of a mouse. In fact, there is quite a lot of invisible work performed by the admin staff. The paper demonstrates how information on cost data and case overview travels and transforms within an organisational hierarchy. The analysis shows that the human impact is not out of the equation, even though some performance information is automatically aggregated. Performance information is indeed a result of cooperation between man and machine. Seeing as information is not a neutral raw material to be easily transported challenges the belief in data-driven organisations as a pure technical matter

What I've Learned from E-Patients

Hoch and Ferguson discuss what they've learned from working with an online support group for people with epilepsy

Tracing Uncertainties in New Prognostics of Consciousness

Uncertainty is a basic condition of medicine - in research, in the clinic and in the intersection between the two domains. Prognostics is in its very nature an attempt to address and manage the uncertainty of the future. New technologies are continuously developed in order to make prognostics more precise and hence make the future more predictable. However, such technologies may not always serve to decrease uncertainty, but rather enhance or introduce new uncertainties, and thereby open other futures than those imagined. Our study follows an interdisciplinary Danish research group currently seeking to advance methods of neuroimaging in prognostics for unresponsive patients with uncertain consciousness due to anoxic brain injury after an out-of-hospital cardiac arrest. Applying an interdisciplinary approach combining ethnographic methods and philosophical analysis we trace the experience of uncertainty in this context of tool development at the intersection of scientific and clinical reasoning around disorders of consciousness. Specifically, we employ and develop the three-dimensional framework of uncertainty developed by Han, Klein and Arora (2011). We identify salient uncertainties from the perspective of the researchers and show how these lead to different uncertainties experienced by the clinicians. Additionally, we show that while ambiguity may be the source of different kinds of uncertainty, the context determines the nature of the source. Our investigation has a descriptive and theoretical focus, however, uncovering these details may serve as a basis for normative discussions of strategies for uncertainty management, as well as evidence evaluation in research and the clinic in the future.&nbsp

Sagsbehandling i en digital virkelighed: Digitalisering, standardisering og individuelle hensyn

The Danish digitisation strategy states that case management systems are one of the means to digital welfare. is article examines Fælles Sprog (common language) which is used by case managers within the area of care for the elderly. Based on interviews the article illustrates how cross pressures from concerns of the in- dividual needs of the clients on the one hand and the system requirements for standardisation on the other hand are handled by the street level bureaucrats. In this way, the article presents e-government in practice within social welfare provision.

Central adrenal insufficiency is rare in adults with Prader-Willi syndrome

CONTEXT: Prader-Willi syndrome (PWS) is associated with several hypothalamic-pituitary hormone deficiencies. There is no agreement on the prevalence of central adrenal insufficiency (CAI) in adults with PWS. In some countries, it is general practice to prescribe stress-dose hydrocortisone during physical or psychological stress in patients with PWS. Side effects of frequent hydrocortisone use are weight gain, osteoporosis, diabetes mellitus, and hypertension-already major problems in adults with PWS. However, undertreatment of CAI can cause significant morbidity-or even mortality. OBJECTIVE: To prevent both over- and undertreatment with hydrocortisone, we assessed the prevalence of CAI in a large international cohort of adults with PWS. As the synacthen test shows variable results in PWS, we only use the metyrapone test (MTP) and insulin tolerance test (ITT). DESIGN: Metyrapone test or ITT in adults with PWS (N = 82) and review of medical files for symptoms of hypocortisolism related to surgery (N = 645). SETTING: Outpatient clinic. PATIENTS OR OTHER PARTICIPANTS: Eighty-two adults with genetically confirmed PWS. MAIN OUTCOME MEASURE: For MTP, 11-deoxycortisol > 230 nmol/L was considered sufficient. For ITT, cortisol > 500 nmol/L (Dutch, French, and Swedish patients) or > 450 nmol/L (British patients) was considered sufficient. RESULTS: Central adrenal insufficiency was excluded in 81 of 82 patients. Among the 645 patients whose medical files were reviewed, 200 had undergone surgery without perioperative hydrocortisone treatment. None of them had displayed any features of hypocortisolism. CONCLUSIONS: Central adrenal insufficiency is rare (1.2%) in adults with PWS. Based on these results, we recommend against routinely prescribing hydrocortisone stress-doses in adults with PWS

Does size really matter? A multisite study assessing the latent structure of the proposed ICD-11 and DSM-5 diagnostic criteria for PTSD

Background: Researchers and clinicians within the field of trauma have to choose between different diagnostic descriptions of posttraumatic stress disorder (PTSD) in the DSM-5 and the proposed ICD-11. Several studies support different competing models of the PTSD structure according to both diagnostic systems; however, findings show that the choice of diagnostic systems can affect the estimated prevalence rates. Objectives: The present study aimed to investigate the potential impact of using a large (i.e. the DSM-5) compared to a small (i.e. the ICD-11) diagnostic description of PTSD. In other words, does the size of PTSD really matter? Methods: The aim was investigated by examining differences in diagnostic rates between the two diagnostic systems and independently examining the model fit of the competing DSM-5 and ICD-11 models of PTSD across three trauma samples: university students (N = 4213), chronic pain patients (N = 573), and military personnel (N = 118). Results: Diagnostic rates of PTSD were significantly lower according to the proposed ICD-11 criteria in the university sample, but no significant differences were found for chronic pain patients and military personnel. The proposed ICD-11 three-factor model provided the best fit of the tested ICD-11 models across all samples, whereas the DSM-5 seven-factor Hybrid model provided the best fit in the university and pain samples, and the DSM-5 six-factor Anhedonia model provided the best fit in the military sample of the tested DSM-5 models. Conclusions: The advantages and disadvantages of using a broad or narrow set of symptoms for PTSD can be debated, however, this study demonstrated that choice of diagnostic system may influence the estimated PTSD rates both qualitatively and quantitatively. In the current described diagnostic criteria only the ICD-11 model can reflect the configuration of symptoms satisfactorily. Thus, size does matter when assessing PTSD